Moved by Baroness Burt of Solihull
13: After Clause 15, insert the following new Clause—“Duty to co-operate: children awaiting NHS treatment(1) The Commissioner must within 6 months after section 15 comes into force issue a request under that section to the NHS bodies in England mentioned in subsection (2) to co-operate with the Commissioner to secure that the objectives set out in subsection (3) are met within 12 months after that section comes into force and continue to be met.(2) The bodies are—(a) every clinical commissioning group established under section 14D of the National Health Service Act 2006, and(b) every other NHS body in England (as defined in section 15(7)) whose co-operation the Commissioner thinks is necessary to secure that the objective set out in subsection (3) is met. (3) The objectives are that—(a) where a child who has been referred for NHS care ortreatment in the area (“Area A”) of a clinical commissioning group moves, as a result of being affected by domestic abuse, to the area (“Area B”) of another clinical commissioning group, the child receives, so far as possible, that care or treatment no later than it would have been received in Area A, and(b) where a child who has been referred for NHS care or treatment in the area of a clinical commissioning group (“Area A”) moves, as a result of being affected by domestic abuse, to Scotland, Wales or Northern Ireland, the NHS bodies in question take the necessary steps (including co-operating with bodies exercising health functions for the area to which the child has moved) to secure, so far as possible, that the child receives that care or treatment no later than it would have been received in Area A.”
My Lords, this small group brings together two amendments that I raised in Committee, both relating to the interests of children in circumstances where they flee domestic abuse with a parent or guardian to a new area. Amendment 13 tackles access to NHS treatment and Amendment 76 concerns access to school places.
On Amendment 13, the noble Lord, Lord Rooker, raised the issue of health being a devolved matter. What happens, he asked, when a child flees from England to Wales or vice versa? Hestia lawyers, who have been very helpful in this whole process, have redrafted this amendment to tackle this point, so I hope that this is now satisfactory in legal terms. I think the noble Baroness, Lady Meacher, will probably have more to say on this point.
As always seems to be the case in this place, extremely knowledgeable Members of your Lordships’ House enhanced the debate with their experience and knowledge in Committee. My noble friend Lady Brinton gave a harrowing real-life example of a family forced to flee, and persistent problems of the children with medical complaints going to the back of the queue each time they were forced to move again by the perpetrator. The noble Baroness, Lady Finlay, spoke about how medical and mental problems seemingly unrelated to the stress of living in a household where abuse was going on arose. The Minister talked about the duties and responsibilities of the NHS to treat people in priority need, but, frankly, that is no consolation if your need is not ostensibly a top priority and you never stay on a waiting list long enough to get seen—or even, as pointed out by the noble Lord, Lord Rosser, to get a diagnosis.
Another point raised by my noble friend Lady Brinton in Committee was to inform the House that the Armed Forces covenant already allowed for this prioritisation to happen for Armed Forces families required to move. I hope the noble Lord the Minister will have looked into this and can tell the House, if it is not practically possible to do the same thing for children fleeing abuse, why it is not. As your Lordships know, where there is a will, there is a way.
Amendment 76 has not changed, and the need for priority admission for children forced to flee to a new area to get schooling has not changed either. Amendment 76 amends the schools’ admissions codes in England and Wales to ensure that children fleeing abuse get the same priority as looked-after children in getting a school place. The noble Lord, Lord Rosser, revealed that it takes on average six to eight months for a child to find a new school place on moving area. In his response, the Minister talked about a consultation on the schools’ admissions code to improve the in-year admissions process and fair access protocols for vulnerable children moving in-year. I appreciate that the Government want to get this right and to make it fair for all. Those of us with local government backgrounds or who have been MPs will know just what lengths some parents are prepared to go to secure a place for their child at what they perceive as a good school.
In his remarks in Committee, the noble Lord, Lord Rosser, talked also about food parcels and the double disadvantage faced by children without a registered school place. From this week, most children will be back at school, so I presume that food parcels will cease, though that does beg the question about children who test positive and are required to self-isolate. Will they get food parcels if they qualify for free school meals? I do not expect the Minister to know the answer to this off the cuff—though I would be impressed if he did—so perhaps he would be so kind as to write to me. But these vulnerable children with no school place will not qualify for free school meals or for anything else. I ask the Minister: how fast can this be sorted out? When will this new code be implemented, and what is the Secretary of State prepared to do as an interim measure to negate the extra disadvantages these children face on a daily basis? I beg to move.
My Lords, I appreciate the time, but I am passionate about Amendment 13, hence my name being on it alongside that of the noble Baronesses, Lady Burt, Lady Brinton and Lady Meacher.
The reason why I am so intrigued by how we treat children suffering from domestic abuse and the effects of having to move around in terms of getting healthcare goes back to when I lost my husband in 2007 and my three daughters were witnesses to that horrific crime. I remember trying to get my daughters some health support from my local commissioner and, failing that, to try to get my youngest daughter to see a therapist due to lack of sleep as a result of the trauma that she suffered. At that time, the response was that nobody could be fast-tracked and that everybody went through the same door. The knowledge of how difficult it is to cope with trauma has never left me—and I did not have to cope with domestic abuse. I was not living in a refuge. I was just trying to do my best to protect my three daughters, who still suffer to this day.
I am really concerned about how we treat children who are getting no services, or services are being delayed, through moving to refuges in different areas. Children fleeing abuse desperately need fast access to healthcare. I appreciate that the Government are trying to get this right, but protected status on an NHS waiting list is necessary for these vulnerable children. As I said, I had difficulty although I did not live with domestic abuse and nor was I fleeing, but the trauma of not being able to get access to the waiting list has never left me.
How do these families which are struggling to get there feel? This is, after all, about individuals—about humanity—so I am grateful to a case study from Hestia. A family is in a refuge; the daughter needs speech therapy appointments and has been put on a list, but the list goes on and on. Azra—the names have been changed—had turned five years old and they were preparing to leave the house because they had to move. No housing options were available in their local area. The window of opportunity to treat her speech development was running out. The mother did not know what to do next for her family.
This is not just a case of receiving medical care for trauma or anything else. It is about having access to care in your local area, wherever you are moved to. I ask noble Lords to look at the amendment and realise how we so easily take our healthcare for granted. In the pandemic, we have seen what brave and heroic people we have in the NHS. I ask the Minister to look at this amendment and do the best she possibly can for a young child who is going through trauma and is being moved around, and for a mother who is trying to get the best possible treatment for their health.
My Lords, I whole-heartedly support Amendments 13 and 76, to which I have added my name. I applaud the noble Baroness, Lady Burt, for tabling these amendments and speaking so powerfully to them.
The key point about Amendment 13 is that a child in need of NHS care really must have that treatment in a timely way, even if the family have had to move to a different NHS trust area. Having worked in mental health for many years, I refer to the point made so powerfully by the noble Baroness, Lady Newlove. If a child needs psychological help—in this case because of the domestic abuse which they have witnessed or experienced—then the timeliness of that therapy is absolutely vital if the child is not to develop serious mental health problems that are going to be very difficult to remediate later on. I am focusing on mental health issues, but long delays are incredibly serious for a child in need of help with their physical health.
Amendment 13 is not onerous for the Government. It simply places a responsibility on the commissioner, within six months of the implementation of the Bill, to work with clinical commissioning groups and other NHS bodies to resolve the problem of rapid access to NHS treatment for these children. That is all the amendment is asking for. I hope that the Minister can accept the aims of the amendment; I am sure that she will. Maybe she can indicate how the Government plan to meet those aims if not by this amendment, although I hope that they will do so by accepting it.
On Amendment 76, to which I have added my name, the noble Baroness, Lady Burt, has cogently argued the case for it, so I shall be brief. I hope that the Minister will take note of the support of the commissioner for the amendment or similar actions to provide
“equivalent priority access to education for children who are victims of domestic abuse.”
While Amendment 13 relates to health, this amendment relates to education. Our aim here is to ensure that these seriously disadvantaged children, having experienced domestic abuse, do not have their disadvantage exaggerated through enforced non-attendance at school. My goodness, we have heard so much about the importance of children attending school when it comes to Covid, but it is even more important, I suggest, for children who have been affected by domestic abuse.
This modest amendment could transform the lives of those children, yet it would surely not impose unreasonable demands on schools. No doubt the commissioner will want to look at the impact on schools to make sure that there was not a problem, but the amendment leaves it to the Secretary of State to decide how the school admissions code should be amended to ensure that those vulnerable children can attend school. I hope that the Minister can respond positively to Amendment 76.
My Lords, I draw attention to my interests as outlined in the register. I am pleased to follow other noble Lords who have made such cogent cases for both amendments in this group. They are designed to ensure that children who move home, away from their current school and health service area because of domestic abuse are not disadvantaged in access to relevant schooling close to their new residence and, as far as is practicable, receive NHS treatment no later than they would have done had they remained at their previous address. This is not about queue jumping, it is about staying at the same level in the queue when you move.
It is intended that there will be a new health and social care Act this year. Is it feasible not only to enshrine Amendment 13 in this Bill but to reflect the principle in the revised health and social care Act? This would enable the Secretary of State for Health to request that all NHS providers aim to meet standards of fair access for children who move home if they have suffered abuse.
With regard to schooling, it is very hard for children to move out of the area to a new school, losing their previous friends, as a result of abuse. If they then have to travel long distances from their new home to a new school, it makes it very difficult to attend after-school clubs and make local friends if their neighbours are attending more local schools. I have seen this happen all over the country.
For this reason, I support Amendment 76 unreservedly. It is essential that children make new friends and study locally to their home to promote social interaction with other local children and access to clubs and out-of-hours activities associated with schools. These networks are essential to promote children’s mental health, particularly those who have suffered abuse.
My Lords, I thank my noble friend Lady Burt and the noble Baronesses, Lady Newlove, Lady Meacher and Lady Watkins, for their careful and thoughtful introduction to, and support for, both the amendments. I also thank the Minister for his comments at the end of Committee on the Bill, but, as others have said, it is certainly easier for the Government to work with Amendment 13, because the responsibility falls on the commissioner to work with the NHS—whether it is CCGs or hospital trusts.
The key point for me is that there is already the ability to choose your hospital, which we do through NHS e-referral services. For these children, fleeing domestic abuse and probably being moved on at extremely short notice, the real crisis is that they will plummet to the bottom of a long waiting list at exactly the crisis moment when they will need support.
I urge the Minister to consider that particular problem. I appreciate all the arrangements that the Government have made. We shall see what is in the NHS Bill, as and when this is published, but this very small, particular group of children need very particular support. This is absolutely the case for children applying to child and adolescent mental health services, where we know that there is already an extreme shortage of access to these services. The one thing that is true about children fleeing domestic abuse is that they are likely to be traumatised. Delaying their treatment further will give them very serious problems.
On the schools issue, I think it is an excellent notion to use the same duties as for looked-after children. I also want to make the point that I made about NHS services in Committee. Military children should also be prioritised for school places when they move. This should apply also to children fleeing domestic abuse.
In certain areas where schools are full, a six to eight-month gap to find a school place is not uncommon. This exacerbates the problem of the children not getting any part of their lives back to normal. I appreciate that processes and protocols take time, but there must be some interim measures to help these children. There is no doubt that this Government understand the importance of getting children back into school. As the noble Baroness, Lady Meacher, has said, the impact of Covid and the pressure on schools to reopen as quickly as is safe is completely understandable. These children’s lives are being traumatised by the pandemic—although perhaps not as severely as those of elderly adults. They need a transformation. They need access to school and medical services.
So I urge the Minister to agree to these amendments and ensure that the processes which need to be set up behind the scenes between the commissioner, NHS services and the DfE can happen.
My Lords, Amendment 13, moved by the noble Baroness, Lady Burt of Solihull, would require NHS bodies to co-operate to allow children who have had to move due to domestic abuse to receive any NHS treatment for which they had been referred no later than if they had not moved. Amendment 76 would extend the duty on local authorities to provide school places for looked-after children to children who are forced to change schools as a result of domestic abuse.
In Committee, the Government’s response to Amendment 13 was the same as it had been in the Commons: namely, that access to the NHS is based on clinical priority and that a child’s need to access and receive health services is assessed and services provided according to clinical need. The response overlooked the point that, in the case of children forced to relocate because of domestic abuse, if the forced move is from an area where the wait following referral could be 18 months to two years to another area where the wait is for a similar period, a clinician might not see that vulnerable child for a lengthy period—literally years—and that any decisions would not be being made by clinicians.
Nor was there any response to another point made in the debate in Committee: namely, that, since the Armed Forces covenant protects service people’s waiting list position if they are redeployed and the family moves home to a new area, why could a similar principle not be applied to children who have to move home to another area due to domestic abuse?
In Committee in this House the Government said:
“When patients move home and change hospitals, the NHS should take previous waiting time into account and ensure, wherever possible, that these patients are not put at a disadvantage as a result … Where the systems or processes of the NHS are an impediment to equitable treatment for this group, it will be important for the NHS to work to ensure that such impediments are removed, and we will support and encourage that.”—[Official Report, 27/1/21; cols. 1727-28.]
In Committee, the Government made no attempt to say whether they either agreed or disagreed that there was a problem of extended delays in waiting times, or whether vulnerable children who had to be relocated due to domestic abuse do or do not receive NHS treatment for which they have been referred no later than if they had not moved.
Could the Minister, in his response today, give us the figures setting out the extent to which children having to relocate due to domestic abuse do or do not receive NHS treatment for which they have been referred no later than if they had not moved? Presumably the Government would not have rejected this amendment in Committee without knowing what the figures were, and thus the extent of the problem and its consequences for the vulnerable children concerned.
Likewise, on the issue of the provision of school places for children who are forced to move location and change their school as a result of domestic abuse, can the Government, if they are not prepared to act on this amendment, provide figures showing the extent to which they consider that there is or is not a problem in respect of the provision of school place for these vulnerable children who need all the support they can get? Like other noble Lords who have spoken in this debate, I look forward to the Government’s response and hope that it will be a positive one.
My Lords, I assure the noble Baroness, Lady Burt of Solihull, that we share her objective that children should not be put at a disadvantage if they are compelled to move home as a result of domestic abuse. It is, of course, right that they should be able to access the medical attention that they need and to secure a new school place quickly, and that any gaps in their education must be kept to an absolute minimum.
In relation to Amendment 11, as the noble Baroness acknowledged, it is a key principle of the National Health Service that access to healthcare is on the basis of clinical need. When patients move home and between hospitals, the NHS should take previous waiting time into account and ensure, wherever possible, that these patients are not disadvantaged as a result. Clinicians have the training and expertise to make decisions about clinical prioritisation so that patients who require urgent treatment can expect to be seen more quickly. Of course, waiting times may vary across the country and between services. Different services experience different challenges in local demand, which can affect waiting times, and it is important that there is local flexibility to manage this. However, regardless of circumstance, clinical commissioning groups and providers have a duty to provide services within the maximum waiting times set out in the NHS constitution, as I set out in Committee and as has been noted again today.
The noble Baronesses, Lady Burt and Lady Brinton, asked about the Armed Forces covenant. The framework of the Armed Forces covenant sets out society’s obligation to members of our Armed Forces and their families, with an aim to prevent disadvantages that they face due to the unique nature of service in our Armed Forces. As part of this promise, families of serving personnel
“should retain their relative position on any NHS waiting list, if moved around the UK due to the service person being posted.”
As I set out earlier, the decision still rests with the clinician to make decisions about their clinical priority in relation to the local population and services available. That is the core principle throughout NHS services.
Local healthcare services are commissioned based on an assessment of the needs of the population they serve, and tackling health inequalities is a core part of those considerations. It will be important for the NHS to learn from experience, including the concerning accounts that have been highlighted by noble Lords both in Committee and this evening, so that barriers to accessing services are removed. We will certainly support and encourage that.
I should say at this point that NHS England is developing an action plan to tackle domestic abuse that will raise awareness among NHS staff. I am sure that staff have the skills to identify and refer and, indeed, to address the issue of NHS staff who are themselves victims or perpetrators. One of the tenets of the action plan will be that any and all victims and survivors of domestic abuse and their children will not be unduly disadvantaged in accessing physical and mental health services when they are forced to move to new accommodation in a different area.
Moreover, at a national level, the NHS long-term plan sets out a number of measures to improve access to services, about which I spoke in Committee, such as extra GP appointments, and new waiting time standards for children and young people for eating disorders and for those experiencing a first episode of psychosis. On top to this, at least 345,000 additional children and young people aged up to 25 will be able to access support via NHS-funded mental health services and school or college-based mental health support teams by 2023-24.
Furthermore, at the spending review in December, the Government announced £1 billion of public money to address backlogs and tackle long waiting lists by facilitating up to a million extra checks, scans and operations. On Friday, the Government announced how millions more children and young people will have access to significantly expanded mental health services, backed by £79 million of public money. This announcement means that nearly 3 million children in England will be supported by mental health support teams in schools, around 22,500 more children and young people will be able to access community mental health services, and 2,000 more children and young people will have access to eating disorder services.
Unlike Amendment 11, Amendment 76 seeks to make provision for both England and Wales, and as education is a devolved matter in Wales, we should not be legislating in your Lordships’ House without the consent of the Senedd. My comments therefore address Amendment 76 as it applies to England only.
The noble Baroness, Lady Burt, has again eloquently explained how children fleeing with a parent from their abuser should not be put at a disadvantage and should not have to wait a long time for a new school place. We agree, which is why the Government are embarking on reform of the English School Admissions Code, which makes better provision for in-year applications and introduces new requirements, including mandatory deadlines for decision-making in relation to in-year admissions and in respect of local authorities’ fair access protocols, helping to ensure that vulnerable school children are allocated a school place as soon as possible. Under the revised code, children fleeing domestic abuse will be eligible to be placed in a school through the fair access protocol if they are struggling to find a school place via the in-year admissions system. These changes should make this process faster and more transparent, and provide a safety net for the most vulnerable children moving school in-year. The Department for Education also proposes to publish new guidance on fair access protocols in England.
The noble Baroness, Lady Burt, asked when the changes to the School Admissions Code will come into force. They are subject to a full public consultation and, of course, to parliamentary approval, but, subject to that approval, we expect the changes to come into force later this year.
The noble Baroness also asked about the numbers affected on free school meals, and I will take up her offer to write with that information.
The noble Baroness suggested the School Admissions Code should change to give children fleeing domestic abuse, or who have had to move home because of domestic abuse, the same priority as looked-after children when there is a waiting list for school places. This proposal and Amendment 76 focus on the application process for a school place in the normal admissions round—that is, at the start of reception or year 7—rather than in the in-year process, which is when children fleeing domestic abuse are more likely to apply. So this amendment would perhaps not help all the people the noble Baroness and all noble Lords, I am sure, have at the forefront of their minds. Although all mainstream state-funded schools in England must maintain a waiting list, they are required to maintain that list only until the end of the first term of the academic year of admission for the school.
We believe that the changes I have outlined to reform the English School Admissions Code to support in-year admissions will have the greatest impact in ensuring that all vulnerable children are able to access a school place as quickly as possible, including those who are affected by domestic abuse. I hope that the changes I have outlined, and the other positive steps to which I have referred, reassure the noble Baroness and, on that basis, she will be content to withdraw her amendment.
My Lords, I am very grateful to all noble Lords who have spoken in this debate, and indeed to the Minister. The noble Baroness, Lady Newlove, gave us another real-life example, this time a personal one. It highlights so clearly the importance of the work that we are doing in this place.
The noble Baroness, Lady Meacher, talked about mental health issues and long delays. Think about the life of a child; 12 months in the life of a five year-old seems a lot longer and more important than 12 months to an adult. It is really helpful that the Minister has elaborated on the additional mental health help that is being planned for young people. Particularly with Covid, it will be greatly needed. I just worry whether we have got the resources and the clinicians to be able to populate the services that we are planning.
The noble Baroness, Lady Watkins, talked about the health and social care Bill this year and whether we might be able to incorporate some of the health amendments into that. This is something the Minister did not refer to. Perhaps he might write to the noble Baroness, Lady Watkins, and other noble Lords who have spoken in this debate. She also talked about the importance of school for all kinds of reasons, including building relationships and getting settled after being in a very disturbed and distressing situation.
My noble friend Lady Brinton talked about plummeting to the bottom of waiting lists at the precise moment that children are at their most vulnerable. The Minister gave soothing words that clinicians are required to take these problems into account. But I hope we can get some reassurance—a protocol—that even if you are not desperately ill, those with a mild condition can still get the treatment they need in a reasonable time, given the vulnerability of these young individuals.
The noble Lord, Lord Rosser, gets to the nitty-gritty, as he always does, and the extent of the problem whereby children lose places on NHS lists. I have started to think that maybe I have not been strong enough in these amendments, when I listen to all the valuable knowledge and the examples that we have had.
My noble friend Lady Brinton also talked about the Armed Forces covenant again. I was struck by the Minister saying that we have an obligation as a society to look after the families of the Armed Forces, but surely we have an obligation as a society to look after these very vulnerable and damaged children as well.
I am very grateful to the Minister for the elaboration and the explanations that he has given. It has been extremely helpful. With that, I beg leave to withdraw the amendment.
Amendment 13 withdrawn.